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Microalbuminuria and short-term prognosis in patients undergoing cardiac surgery

Martin Majlund Mikkelsen1, Niels Holmark Andersen, Thomas Decker Christensen

  • 1Department of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. majlund@ki.au.dk

Interactive Cardiovascular and Thoracic Surgery
|June 25, 2009
PubMed
Abstract

Insights

Preoperative microalbuminuria (MA) in cardiothoracic surgery patients did not increase most adverse outcomes but raised sepsis risk. Adding MA to the EuroSCORE did not improve its accuracy for predicting outcomes.

Area of Science:

  • Cardiology
  • Nephrology
  • Surgical Outcomes

Background:

  • Microalbuminuria (MA) is a marker of endothelial dysfunction.
  • Its role in predicting adverse outcomes after cardiothoracic surgery is unclear.
  • The additive EuroSCORE is used to predict mortality and morbidity in these patients.

Purpose of the Study:

  • To investigate the association between preoperative microalbuminuria (MA) and adverse outcomes in patients undergoing elective cardiothoracic surgery.
  • To determine if MA improves the predictive accuracy of the additive EuroSCORE.

Main Methods:

  • A follow-up study included 962 patients undergoing elective cardiothoracic surgery.
  • Microalbuminuria was assessed using the urine albumin/creatinine ratio in spot-urine samples.
  • Outcomes included all-cause death, myocardial infarction, stroke, atrial fibrillation, reintervention, renal insufficiency, wound infection, and septicaemia, with 30-day follow-up.

Main Results:

  • Microalbuminuria was present in 18.7% of patients.
  • MA was not associated with increased risk of most combined or individual adverse outcomes.
  • Patients with MA had a higher risk of postoperative septicaemia (OR: 12.1) and marginally longer ICU and hospital stays.
  • The additive EuroSCORE's accuracy for 30-day mortality remained unchanged with MA information.

Conclusions:

  • Preoperative microalbuminuria is not a significant predictor for most early adverse outcomes in elective cardiothoracic surgery.
  • However, it is associated with an increased risk of septicaemia and slightly prolonged hospital stay.
  • Incorporating MA into the additive EuroSCORE does not enhance its predictive performance.

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